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Medicine Notes Psychiatry Notes

Neurotic Disorders Notes

Updated Neurotic Disorders Notes

Psychiatry Notes

Psychiatry

Approximately 43 pages

Clinically-relevant notes for medical finals. Includes all the common psychiatric conditions along with notes on dementia and child psychiatry. Colour coded per topic. Easy to follow and breaks down the main presenting features and treatments (both drugs, psychological therapies and ECT)
Very useful for finals revision....

The following is a more accessible plain text extract of the PDF sample above, taken from our Psychiatry Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Neurotic Disorders

Neurosis

‘Disorders that have three things in common’

  1. Not accompanied by organic brain disease

  2. Not psychoses

  3. Discrete onset (rather than a continuous development from early life)

Anxiety + Anxiety Disorders

Anxiety

‘An unpleasant emotional state or condition, which is characterized by subjective feelings of tension, apprehension and worry by activation of the autonomic nervous system’

Perceived danger

Limbic system

Sympathetic nervous system activated

Release of noradrenalin and adrenaline (from adrenals)

Physiological effects

Anxiety is a normal human response to many every-day situations

Anxiety disorders = more intense, last longer and lead to problems that interfere with everyday life. They occur because people believe situations to be more dangerous than they actually are

Three components of Anxiety

  • Physical symptoms

    • Cardiovascular

      • Tachycardia

      • Chest pain

      • Palpatations

    • Respiratory

      • Tachpnoea

    • CNS

      • Syncope

      • Pre-syncope

      • Headache

      • Insomnia

    • Other

      • Urinary frequency

      • Diarrhoea

      • Tremor

Panic attacks

= Brief intense episodes of anxiety

  • Can occur in any of the anxiety disorders

  • Hyperventilation is common

Phobic Anxiety Disorders

Phobia = anxiety in response to a specific situation

Degree of anxiety is out of proportion to situation

3 Phases

  • Anticipatory anxiety

  • Physical and psychological symptoms of anxiety

  • Avoidance or escape

Agoraphobia

Women>Men

‘Anxiety about being in places or situations from which escape might be difficult or in which help might not be available in the event of having an unexpected or situationally predisposed panic attack or panic-like symptoms’

  • Anxiety about leaving the home, entering shops, using public transport etc

  • Gradual escalation of symptoms over time

  • Must NOT be the result of delusions/hallucinations

Social Phobia

Men>Women

Anxiety symptoms provoked by social situations in which the person feels ‘on display’ in some way e.g speaking to audience, eating in public

  • Impacts on job and lifestyle

  • Low self esteem

  • Fear of criticism

Specific Phobias

Anxiety aroused by a particular objects

  • Spiders, dogs, thunderstorms

Commonest Phobia

  • Least disabling provided the object can be avoided

  • Person recognizes emotional distress is excessive/unreasonable

Panic Disorder

  • Repeated panic attacks occurring over a short period of time

  • Not predictable or in response to a particular stimulus

  • No symptoms between attacks

  • Several panic attacks within a month

Need 4 of 14 symptoms

  • Palpatations

  • Sweating

  • Trembling

  • Hot flushes

  • Dyspnoea

  • Choking sensation

  • Chest pain

Generalised Anxiety Disorder

Women>Men

Symptoms of anxiety present most of the time for >6 months

No direct cause or obvious trigger

Often as severe at home as when out of the house

Tends to occur on the background of chronic social problems

  • Mental illness

  • Unemployment

  • Lack of support

Symptoms include

  • Apprehension

  • Motor tension (tension headache)

  • Autonomic over-activity

  • +/- Depressive symptoms

Can be a presenting feature of depressive illness

Differential diagnosis of anxiety disorders

  • Depression

  • Drug and alcohol withdrawal

  • Schizophrenia

  • Dementia

  • Thyroid disease

Management of Anxiety Disorders

Drug treatment

  • For severe and chronic anxiety mainly

    • Benzodiazepines

      • Problems of tolerance and dependence

      • Try to avoid if possible

      • If using, prescribe low dose and short duration

    • B Blockers

      • Symptomatic relief of palpatations

    • Antidepressants e.g SSRIs

      • Useful even in absence of depressive symptoms

      • Higher doses needed than in depression treatment

      • Increased anxiety initially, few weeks for full effects (6 weeks)

    • Buspirone (anti-psychotic)

      • Similar to benzodiazepine but no dependency problems

    • Pregabalin (anticonvulsant)

Psychological treatment

  • Explanation and reassurance re...

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